The value of mercury in the treatment of dysentery is a question upon which very opposite opinions are held. While some writers warmly advo cate its use, others as warmly denounce its employment. The tendency of the present day, however, appears to be to neglect mercurials in favour of ipecacuanha. Dr. Morehead was accustomed to prescribe a combina tion of calomel or blue pill, ipecacuanha, and opium, every four, six, or eight hours ; and to give, in addition, a small, occasional close of castor-oil. This treatment he considered especially applicable to the first few clays of the disease, although it is also suitable at a later period. He relates the case of a child, three years of age, had been ill with dysenteric symp eighteen days. Two grains of ipecacuanha, three of extract of gentian, and one each of Dover's powder and blue pill, were given every three hours, with great benefit. When, after a few days, feculent matter reappeared in the stools, the opium was omitted from the prescription, and the other remedies were given for some days longer.
Whether mercury be given according to this method, or the child be treated with ipecacuanha alone, as is the more modern practice, an occa sional dose of castor-oil is often indicated. If the abdomen becomes full and tense, and the dejections are scanty, a dose of the oil (two teaspoonfuls to a child ten years of age) may be given with advantage. If the tenesmus is distressing, an enema of starch and opium, in the proportions already recommended, may be used at sufficient intervals. If, towards the end of the disease, the child appears much enfeebled, the brandy-and-egg mix ture should be given.
In the case of an infant, the treatment varies in some degree from that found useful in older children. Ipecacuanha is not to be recommended for patients under twelve months old ; for, according to Mr. Scriven, in fants of this age do not bear well the nausea and starvation which this treatment involves. For these patients calomel is a preferable remedy. To a child eight or ten months old half a grain of calomel may be given morning and evening, and an enema containing one or two drops of laud anum twice in twenty-four hours. Mr. Scriven speaks highly of lancing the gums in all cases of dysentery in teething infants. He disapproves of farinaceous foods ; and even milk—unless the child be at the breast—he considerably restricts in quantity, preferring to rely for nourishment upon beef-tea and chicken-broths. As in the case of other forms of bowel complaint, these meat-broths may be advantageously combined with an equal proportion of barley-water.
In no instance should the ordinary astringent remedies be used while the illness is acute ; but when the disease passes into the chronic stage, they may be judiciously resorted to. In such cases, large doses of bismuth
with aromatic chalk may be given ; rhatany and catechu are often of ser vice ; and the pernitrate of iron is an especially valuable remedy. Ene mata of weak nitrate of silver (half a grain to the ounce) are often of con siderable value, the bowels having been previously cleared out by a copious injection of warm water. These injections should be large, and must be given very slowly. For a child ten years old a couple of pints may be used. Instead of a nitrate of silver injection, simple warm water may be employed, or a 5olutiou of alum (gr. xv. to the ounce) as recommended by Mr. Scriven. While these remedies are being made use of the child should take a daily dose of Dover's powder, if the straining and abdom inal pain continue.
Cases which have resisted treatment by astringents will sometimes yield readily to ipecacuanha in closes of one grain three times a day, with an occasional injection of laudanum and ipecacuanha in warm starch if the tenesmus is distressing. At the same time the food should consist of strong meat-essence, well-boiled rice, pounded under-done meat, and boiled milk, if it agree. Eggs are often not well borne in these cases.
A remedy which is very useful in the chronic stage of dysentery is the perchloride of mercury given in quantities of ten or fifteen drops several times in the day. It may be usefully combined, as Dr. Ellis has sug gested, with the tincture of cinchona. Sometimes the perchloride • has been found to be more useful in very small doses frequently repeated, as five drops every two or three hours. In any case, if the close is small it must be repeated more frequently in the day.
In all cases of chronic dysentery, great care should be taken that the belly is duly protected from alternations of temperature by a broad flannel bandage, that every attention is paid to promoting the action of the skin, and that the surface of the body is kept perfectly clean. A complete change of climate to a bracing sea-air is of the utmost service in complet ing the cure.
During convalescence from dysentery the child's appetite is often enormous. Great watchfulness must be therefore used that he do not eat a quantity of indigestible substances, such as new potatoes, unripe fruit, or great excess of farinaceous matters and sweets. He should live prin cipally upon meat once cooked, eggs, fresh-made broths and milk, and wine, in the shape of port or sound claret, may be allowed him with his dinner.